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Small Intestinal Submucosa for corporeal body grafting in patients with proximal hypospadias and severe chordee: Long term follow-up assessing erectile function and genital self-perception

      Summary

      Background

      Proximal hypospadias and severe ventral chordee are often challenging to repair. To preserve penile length in chordee repair, Small Intestinal Submucosa (SIS) corporal grafting is often performed with potential long-term complications including recurrent curvature and erectile dysfunction (ED). There is a paucity of data evaluating sexual function in mid, late and post-pubertal patients.

      Objective

      We aimed to assess long-term outcomes of genital self-perception and erectile function in mid, late and post-pubertal patients who underwent single-layer (1-ply) SIS corporal body grafting for correction of severe chordee.

      Study design

      Patients with proximal hypospadias who underwent correction of severe chordee using SIS grafting between 2001 and 2015 were retrospectively identified. Patients were evaluated for erectile and sexual function using the modified erection hardness score (mEHS) and the modified sexual health inventory for men (mSHIM). Perceived function and straightness were measured with Hypospadias Objective Scoring Evaluation (HOSE). Penile self-perception was assessed using the Pediatric Penile Perception Score (PPPS). Results were compared to an age-matched healthy control group. Categorical variables were analyzed using Fisher's exact test, and continuous variables using paired and unpaired t-test and ANOVA.

      Results

      Nineteen patients with proximal hypospadias who underwent correction of severe chordee using SIS grafting and 18 controls participated in the study with a median age of 17 years for both groups. In the mEHS, 12 (63.2%) hypospadias-patients and 14 (87.5%) controls rated their erections as completely hard and very rigid. In the mSHIM, 1 (5.2%) hypospadias-patient was classified as having moderate ED. A total of 16 hypospadias-patients (84%) and 16 controls (88.9%) reported being very satisfied or satisfied with the straightness of their penis. No significant difference was observed in the mEHS, mSHIM and PPPS between groups (p < 0.05). The straightness of the erection was rated lower by participants, than by the pediatric urologist. In the HOSE, 12 (63.2%) hypospadias-patients and 16 (88.9%) controls obtained an acceptable score.

      Discussion

      Our findings indicate favorable long-term outcomes in ED and genital self-perception; only 5% of our population reported having a mild-moderate to moderate presentation of ED, and there were no reports of severe ED. The overall PPPS satisfaction rates were statistically similar for the control and hypospadias groups. The small sample population limits the significance of our findings.

      Conclusion

      Summary TableComparison of outcomes from penile self-perception between the clinical and control group.
      Very satisfied Satisfied Dissatisfied Very dissatisfied p-value
      Cases Controls Cases Controls Cases Controls Cases Controls
      Length of penis 4 (21%) 2 (11%) 11 (58%) 16 (89%) 2 (10%) 0 2 (10%) 0 0.16
      Position and shape of urethral opening 9 (47%) 7 (39%) 9 (47%) 11 (61%) 0 0 1 (5%) 0 0.55
      Shape of glans 9 (47%) 8 (44%) 9 (47%) 10 (55%) 0 0 1 (5%) 0 0.62
      Shape of penile skin 7 (37%) 4 (22%) 11 (58%) 13 (72%) 0 1 (6%) 1 (5%) 0 0.43
      Penile axis (straightness) 5 (26%) 6 (33%) 11 (58%) 10 (55%) 2 (10%) 2 (11%) 1 (5%) 0 0.76
      General appearance 6 (31%) 6 (33%) 10 (53%) 11 (61%) 1 (5%) 1 (6%) 2 (10%) 0 0.59

      Keywords

      Abbreviations:

      SIS (Small Intestinal Submucosa), mEHS (Modified Erection Hardness Score), mSHIM (modified Sexual Health Inventory for Men), HOSE (Hypospadias Objective Scoring Evaluation), PPPS (Pediatric Penile Perception Score)
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